Distinguishing body mass and activity level from the lower limb: can entheses diagnose obesity?

The ability to estimate body size from the skeleton has broad applications, but is especially important to the forensic community when identifying unknown skeletal remains. This research investigates the utility of using entheses/muscle skeletal markers of the lower limb to estimate body size and to classify individuals into average, obese, and active categories, while using a biomechanical approach to interpret the results. Eighteen muscle attachment sites of the lower limb, known to be involved in the sit-to-stand transition, were scored for robusticity and stress in 105 white males (aged 31-81 years) from the William M. Bass Donated Skeletal Collection. Both logistic regression and log linear models were applied to the data to (1) test the utility of entheses as an indicator of body weight and activity level, and (2) to generate classification percentages that speak to the accuracy of the method. Thirteen robusticity scores differed significantly between the groups, but classification percentages were only slightly greater than chance. However, clear differences could be seen between the average and obese and the average and active groups. Stress scores showed no value in discriminating between groups. These results were interpreted in relation to biomechanical forces at the microscopic and macroscopic levels. Even though robusticity alone is not able to classify individuals well, its significance may show greater value when incorporated into a model that has multiple skeletal indicators. Further research needs to evaluate a larger sample and incorporate several lines of evidence to improve classification rates.